Critical Care Nursing Commons^™

Unlocking Icu Barriers: Investigating The Challenges Of Early Progressive Mobility, Leslie S. Bigler

Doctoral Projects

Approximately 800,000 patients in the United States annually are admitted to the Intensive Care Unit (ICU) due to critical illnesses and prolonged immobility contributes to poor patient outcomes. While existing data demonstrates early and progressive mobility helps improve outcomes, adherence remains inconsistent for a variety of reasons such as safety concerns, staffing, and lack of knowledge and confidence of mobilization techniques. This quality improvement project, conducted in a 20-bed Medical Intensive Care Unit, asked staff to identify barriers to adherence to mobility protocols. Nurse managers and clinical educators play a crucial role in addressing these issues using strategies such as …

Implementation Of An Evidence-Based Hospital Acquired Pressure Injury Strategy In The Intensive Care Unit, Tonya C.W. Brigman

Student Scholarly Projects

Practice Problem: Hospital-acquired pressure injuries (HAPI) are a significant concern in healthcare with the most vulnerable group being the adult patients in ICUs leading to increased morbidity, longer hospital stays, and higher healthcare costs.

PICOT: In adult ICU patients (P) does the implementation of daily chlorhexidine gluconate (CHG) baths with post bath barrier cream combined with intentional turning every 2-hours (I) compared to standard skin care practices and nonintentional turning (C) reduce the incidence of hospital-acquired pressure injuries (HAPI) (O) within 10-weeks (T)?

Evidence: The project was based on the analysis of the literature published in the …

Improving Parent And Nurse Communication Using The Lowline Model In The Cvicu, Nelli Hodorff Noor

DNP Projects

This project was designed to help improve family and nurse communication using the LOWLINE model in the CVICU to allow families and nurses to be on the same page and work as a team.

Obstetric Education For Critical Care Nurses, Anna Forberg

DNP Projects

Background The purpose of this study was to educate ICU nurses on the care of obstetric women in critical care through the use of a toolkit with intentions to increase knowledge and confidence.

Method The toolkit was created via the platform WordPress™ and topics were chosen based on the most common admission diagnoses found during the literature review. Data were collected via forms manager and voluntary participation among ICU nursing staff was obtained.

Results Mean scores from the pretest to the post-test showed improvement from 7.08 to 8.50 and the minimum and maximum scores increased from pretest to post-test supporting …

Reducing Rates Of Blood Culture Contamination In The Emergency Room, Erika Goldberg

Student Scholarly Projects

Practice Problem: In one emergency room (ER) blood cultures (BC) drawn by nurses had a high contamination rate due to lack of collection standards, which lead to poor patient outcomes.

PICOT: The PICOT question that guided this project was; In adult emergency room patients where blood cultures are drawn (P), how does implementation of an evidence-based practice method (I), compared to the standard method of obtaining blood cultures (C), affect blood culture contamination rates (O), within ten weeks. (T)?

Evidence: Based on multiple sources within the literature; best evidence for lowering blood culture contamination rates (BCC) is done using EBP …

Nurse Retention Amid Workplace Adversity: Examining Strategies And Outcomes, Horace Smith

Student Scholarly Projects

Practice Problem: This project aimed to evaluate the effectiveness of nurse retention strategies in enhancing job satisfaction, focusing primarily on Emergency Department (ED) Registered Nurses (RNs). A comprehensive approach was adopted within the ED of a veteran hospital in the Southeast, aimed at promoting staff retention.

PICOT: The PICOT question guiding this project is as follows: In a veteran hospital's Emergency Room (ER) located in the southeast (P), how does the implementation of nurse retention strategies (I) compared to current standards (C) increase their job satisfaction (O) over a period of ten weeks (T)?

Evidence: This project …

Implementation Of Chlorhexidine Gluconate Dressings And The Effect On Bloodstream Infections In Extracorporeal Membrane Oxygenation Patients At A Pediatric Hospital, Kaitlin Vernier

Dissertations

Extracorporeal membrane oxygenation (ECMO) is an advanced lifesaving therapy used for patients with significant cardiorespiratory failure not responding to conventional therapies. The most common and life-threatening complications associated with ECMO are blood stream infections (BSIs). In addition to increased mortality, BSI's increase patient length of stay and cost. Chlorhexidine Gluconate (CHG) is known to be a significant factor in BSI reduction. The purpose of this quality improvement project is to assess the utilization of CHG-impregnated dressings on the incidence of BSI rates in pediatric ECMO patients. The setting was a 40-bed pediatric intensive care unit (PICU) and a 30-bed cardiac …

Wiping Out Central Line Associated-Bloodstream Infections: Cleaning High Touch Surfaces In The Picu, Emily Heth

Dissertations

Problem: Central line-associated bloodstream infections (CLABSIs) are a significant, preventable healthcare-related complication of hospital admission and medical management of critically ill and medically complex patients. CLABSIs result in significant adverse outcomes such as increased morbidity and mortality, prolonged length of stay (LOS) in the intensive care unit (ICU) and in the hospital, increased cost of treatment, and increased rates of readmission. Direct and indirect contact within the patient’s hospital environment are potential means of transmission for microorganisms, increasing the inherent risk of acquiring a CLABSI.

Method: For this quality improvement (QI) project, a pre-post design was utilized to evaluate the …

Implementation Of A Standardized Nursing Handoff In A Pediatric Intensive Care Unit, Tori Keeven

Dissertations

Handoff communication is critical in healthcare and is associated with patient safety outcomes. Various tools and interventions are available to improve handoff communication as inadequate communication contributes to medical errors, patient adverse events, and increased mortality. The implementation of a standardized handoff tool has been shown to be effective. Findings revealed a significant 60% reduction in reported patient harm events, despite the study's limited sample size and lack of statistical significance (p = .614). Challenges such as low utilization (18.62%) were attributed to concerns about tool organization, spatial constraints, and staff resistance to change. Recommendations include refining the tool to …

Addressing Daily Compliance Of Central Line Discussions In A Pediatric Cardiac Intensive Care Unit, Caitlin Sherwood

Dissertations

Purpose: The purpose of this project was to determine the impact of targeted education on the consistency of central line discussions during daily, multidisciplinary rounds in a pediatric cardiac intensive care unit.

Method: The Kellogg Logic Model was utilized to guide this project. Education was created and presented to bedside nurses working within the unit regarding the importance of daily central line discussion and the impacts of central line associated blood stream infection on patients. The rate of central line discussion was collected pre- and post-intervention to assess effectiveness of the education.

Findings: This project failed to …

A Guideline-Based Approach To Increase Early Mobilization In The Pediatric Patient Following Cardiothoracic Surgery, Kayla Keeven

Dissertations

A Guideline-Based Approach to Increase Early Mobilization in the Pediatric Patient Following Cardiothoracic Surgery

Problem: Prolonged bedrest during the post-operative period contributes to complications that lengthen hospital stay and increase mortality and medical costs. Early mobilization is recognized as safe and feasible in critically ill children. However, there is no standardized procedure nor method of identifying patients who are safe to mobilize in a pediatric cardiac intensive care unit (ICU).

Method: The quality improvement (QI) project employed a descriptive observational design utilizing a retrospective-prospective method to assess the effects of implementing an early mobilization guideline in a pediatric cardiac ICU. …

Management Of Post-Extubation Dysphagia Using The Yale Swallow Protocol, Nicole West

Dissertations

Abstract

Problem: Post extubation dysphagia (PED) increases the patient’s risk for long term complications contributing to increased healthcare cost. Intensive care settings rarely use standardized swallow screening assessments for patients post extubation leading to variation in the evaluation of PED. Variation in the assessment of swallowing post extubation can lead to the missed diagnosis of patients with dysphagia.

Methods: This quality improvement (QI) project was a prospective cohort study implementing an evidence-based swallow screening protocol, the Yale Swallow Protocol (YSP), in an intensive care unit. This study was conducted over four months, which included a pre survey, education, implementation, and …

Daily Alarm Rounds: Enhancing Interdisciplinary Communication And Reducing Perceived Alarm Burden In Bedside Nurses., Shelby Mangeot

Doctor of Nursing Practice Papers

Purpose: The Joint Commission established alarm management as a national patient safety goal in 2013 and has continued this goal through 2023 (2022). This goal mandates hospitals to prioritize alarm system management and establish evidence-based techniques to manage and reduce nuisance alarms. The purpose of this quality improvement project was to provide bedside nurses with education about excessive alarm burden and evidence-based alarm management techniques, then implement a daily bedside alarm rounding tool to enhance interdisciplinary communication and address patient alarm limits during daily rounds.

Methods: After extensive review of the literature, prompts discussing daily alarm limits were added to …

Nutric: Enhancing Surgical Intensive Care Unit Patient Nutrition Consultations, Misty Armstrong

Doctor of Nursing Practice Projects

Background: Daily nutritional screenings in the critical care population can identify patients in need of nutritional modifications during hospital admission. Inadequate nutritional assessments of critically ill patients lead to poor outcomes. Daily nutritional assessments result in the early identification of patients at risk for nutritional compromise compared to weekly assessments.

Purpose: The purpose of this project was to incorporate a daily nutritional assessment using the Nutrition Risk in the Critically Ill (NUTRIC) scores for patients in a surgical intensive care unit to identify patients in need of a referral to a registered dietician.

Methods: The method for this project used …

Ekg Is Key: A Quality Improvement Project To Decrease Door-To-Ekg Time In A Rural Emergency Department, Amanda Southwell

Doctor of Nursing Practice Projects

Background: Electrocardiograms (EKGs) are the priority when evaluating patients with chest pain who present to the Emergency Department (ED). The American Heart Association and other governing bodies suggest a 10-minute door-to-EKG (DTE) time. The target facility displayed a delay in DTE times.

Purpose: The Doctor of Nursing Practice (DNP) quality improvement (QI) project aimed to decrease the average DTE time for patients over 18 years old with chest pain who presented to the ED registration area.

Methods: The DNP project consisted of an EKG suite to perform EKGs near the ED registration/triage area. Registration and ED staff were educated on …

Communication, Electrodes, Appropriateness Setup, And Education (Cease) Bundle Implementation In The Surgical Intensive Care Unit, Tina J. Garcia Miller

All Doctor of Nursing Practice (DNP) Scholarly Projects

An estimated 85-99% of alarms in the intensive care unit (ICU) do not require nursing intervention. This overabundance of non-actionable alarms can contribute to sensory overload and is a significant factor in alarm-related safety events. The aim of this project was to reduce the prevalence of non-actionable alarms through the implementation of an evidence-based alarm management bundle. The CEASE Bundle, a comprehensive five-step protocol encompassing Communication, Electrodes, Appropriateness, Setup, and Education, was implemented in an 11-bed surgical intensive care unit. Continuous alarm data was collected for 12 weeks before and 12 weeks after the implementation of the bundle for comparative …

A Quality Improvement Project To Reduce Facility-Acquired Pressure Injuries, Carolina Rosario

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Facility-acquired pressure injuries (FAPIs) pose significant risks to patient outcomes and healthcare costs ($500 to $70,000 per PI) in subacute rehabilitation (SAR) facilities. An assessment in a SAR identified a concerning pressure injury (PI) rate of 15.3%, exceeding the national benchmark of 10% for such facilities. This prompted an evidence-based quality improvement (QI) initiative.

Aim of the Project: This project aimed to reduce FAPI rates by 30% or greater among patients 65 and older using a PI prevention bundle called SSKINS (Skin, Surface, Keep moving, Incontinence/moisture, Nutrition/hydration, Self-management).

Review of the Evidence: A comprehensive literature review indicated that PIs …

The Impact Of Prone Ventilation Among Patients Diagnosed With Acute Respiratory Distress Syndrome, Mary Steward, Kimberly Loomis

Nurse Residency

Background Mechanical ventilation is a commonICU intervention for patients in respiratory distress. Proning is a form of mechanical ventilation that has been recently studied which improves gas exchange and lung perfusion among patients specifically diagnosed with ARDS.

Ultrasound Guided Piv Insertion Implementation, Blake Hotchkiss, Beth O'Donnell, Miles Merwin, Billie Jo Senecal, Ronica Smith, Eric Alan, Bryan Tavary, Chelsea Harkins, Taylor Archard, Leslie Geissinger, Lauren Remington

Operations Transformation

Observed high number of unsuccessful peripheral IV insertion attempts. This increases waste (cost and time) and decreases patient satisfaction.

Blunt Cerebrovascular Injury (Bcvi): Universal Cta Neck Screening At Level 2 Trauma Center, Tamine Gogel

Doctor of Nursing Practice Projects

Blunt Cerebrovascular Injury (BCVI) refers to injuries to the vessels supplying blood to the brain, primarily carotid and vertebral arteries, and can result from trauma, resulting in stroke by vessel dissection, thrombus formation, embolization, and hemorrhage. Timely identification is crucial for effective intervention and improved outcomes. This doctoral project proposes the implementation of universal screening using Computed Tomography Angiography (CTA) of the neck during initial workup for blunt force trauma at a Level II ACS-verified trauma center. The primary objective is to mitigate potential delays in diagnosing and treating BCVI, thereby reducing the likelihood of complications. Patients ≥ 15 years …